Timeline of Cellulitis and Late Development of Hydrothorax Induced by a Right-Sided Central Venous Catheter: Report of a Case

• Published in: JPEN. Journal of parenteral and enteral nutrition 2010-05, Vol.34 (3), p.341-343
• Main Authors: Westermann, Sanne A., Pahlplatz, Paul V. M., Brouwers, Mark A. M.
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Breast Diseases - diagnostic imaging; Breast Diseases - etiology; Catheterization, Central Venous - adverse effects; Catheters, Indwelling - adverse effects; Cellulitis - diagnostic imaging; Cellulitis - etiology; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Emergency and intensive care: techniques, logistics; Female; Humans; Hydrothorax - diagnostic imaging; Hydrothorax - etiology; Intensive care medicine; Medical sciences; Osmolar Concentration; Parenteral Nutrition - adverse effects; Perfusions. Catheterizations. Hyperbaric oxygenotherapy; Radiography; Vena Cava, Superior - injuries; Vena Cava, Superior - pathology
• ISSN: 0148-6071; 1941-2444
• DOI: 10.1177/0148607109348611

We reported a case of 27-year-old woman who suffered a hydrothorax induced by a central venous catheter that had been placed to facilitate parenteral nutrition. The central venous catheter was inserted into the superior vena cava through the right subclavian vein. Chest radiograph after insertion revealed proper position of the tip. After a few days, the patient developed acute cellulitis of the right breast, and intravenous antibiotics were started. Four days later, 10 days after the insertion of the catheter, the patient suddenly developed dyspnea and tachycardia. Computed tomography scan of the chest showed massive pleural effusion in the right thorax and a mediastinal shift; the tip of the catheter had perforated the superior vena cava and was located in the right pleural space. Thoracic and subcutaneous drainage showed a fluid similar to parenteral nutrition. The continuous mechanical force of the catheter tip against the superior vena cava wall in combination with a hyperosmolar solution was considered to be the cause of the acute cellulitis and a delayed hydrothorax.